Patient characteristics and predictors of mortality in 470 adults admitted to a district general hospital in England with Covid-19

ABSTRACT

BackgroundUnderstanding risk factors for death in Covid-19 is key to providing good quality clinical care. Due to a paucity of robust evidence, we sought to assess the presenting characteristics of patients with Covid-19 and investigate factors associated with death. MethodsRetrospective analysis of adults admitted with Covid-19 to Royal Oldham Hospital, UK. Logistic regression modelling was utilised to explore factors predicting death. Results470 patients were admitted, of whom 169 (36%) died. The median age was 71 years (IQR 57-82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n=218, 46.4%), diabetes (n=143, 30.4%) and chronic neurological disease (n=123, 26.1%). The most frequent complications were acute kidney injury (n=157, 33.4%) and myocardial injury (n=21, 4.5%). Forty-three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation Independent risk factors for death were increasing age (OR per 10 year increase above 40 years 1.87, 95% CI 1.57-2.27), hypertension (OR 1.72, 1.10-2.70), cancer (OR 2.20, 1.27-3.81), platelets <150x103/{micro}L (OR 1.93, 1.13-3.30), C-reactive protein [≥]100 {micro}g/mL (OR 1.68, 1.05-2.68), >50% chest radiograph infiltrates, (OR 2.09, 1.16-3.77) and acute kidney injury (OR 2.60, 1.64-4.13). There was no independent association between death and gender, ethnicity, deprivation level, fever, SpO2/FiO2 (oxygen saturation index), lymphopenia or other comorbidities. ConclusionsWe characterised the first wave of patients with Covid-19 in one of Englands highest incidence areas, determining which factors predict death. These findings will inform clinical and shared decision making, including the use of respiratory support and therapeutic agents. SummaryIncreasing age, hypertension, cancer, platelets <150x103/{micro}L, CRP[≥]100 {micro}g/mL, >50% chest radiograph infiltrates, and acute kidney injury predict in-hospital death from Covid-19, whilst gender, ethnicity, deprivation level, fever, SpO2/FiO2 (oxygen saturation index), lymphopenia and other comorbidities do not.